CT-cisternography in the diagnosis and treatment of non-traumatic cerebrospinal fluid rhinorrhoea: Clinical series and literature review
Keywords:non-traumatic CSF rhinorrhoea, diagnostics, CT-cisternography, treatment
Introduction. Cerebrospinal fluid (CSF) rhinorrhoea— is leakage of CSF into nasal cavity due to defects in the bones of the skull base and dura mater of different etiology. CSF rhinorrhoea is divided into two major types — non-traumatic and traumatic.
Methods. To evaluate the efficacy of CT-cysternography in diagnosis of non-traumatic CSF rhinorrhoea 143 patients were examined. All patients underwent intrathecal introduction of nonionic contrast agents followed by CT-scanning.
Results. According to CT-cysternography data, we obtained evacuation of contrasted CSF from subarachnoid space in all of patients. The “CSF trace” allowed us to identify the precise positioning of CSF fistula and to precisely determine “target” for surgery. In 122 (85.3%) patients the defect of the skull base was present in the area of anterior cranial fossa — in ethmoid bone, in 21 (4.7%) — in the area of sphenoid sinus. In all cases the diagnosis was confirmed during the surgery.
Conclusions. Non-traumatic CSF rhinorrhoea most frequently occurs in middle-aged women with accompanying obesity and hypertension. CT-cysternography allowed us to determine the source of non-traumatic CSF rhinorrhoea in all cases. Precise identification of dimensions of CSF fistula and its localization allowed us to apply with high grade of efficacy transnasal approach in non-traumatic CSF rhinorrhoea surgery.
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